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Tuesday, May 29, 2012

On May 28, I keynoted the Canadian eHealth 2012 Conference, focusing on the need to innovate in the areas of EHR usability, frictionless health information exchange, novel analytics, patient/family engagement, and privacy protection.

I talked to dozens of people during my 24 hours in Vancouver and I believe there are 5 areas that Canadians should address to enhance their national healthcare IT program.

1. Enable innovation via grant programs, competitive challenges, and high risk/high reward projects for emerging technologies, recognizing that traditional procurement approaches can inhibit innovation. Procurement generally includes complex legal boilerplate plus certification that the technology is already running in referenceable customer sites. No innovative startup is going to agree to these terms and conditions. Customer references for new technologies are likely to be scant because it is evolving so fast. Traditional procurement approaches are likely to acquire technology at the end of its lifecycle.

2. Prioritize Patient and Family engagement - to date, much of the Canadian healthcare IT program has focused on acute care hospitals. Although some patient portals have been created, there is no national priority to engage patient and families. Given the importance of shared decision making, keeping the patient informed, and transparency, encouraging interoperability with patients is key.

3. Consider a Meaningful use type program even thought it may be politically unpopular among clinicians. Canada has encouraged clinicians to acquire technology and has set interoperability standards nationally. However, it has not specified the best practices for using the technology or held clinicians accountable for their IT behaviors. There is a fear that pushing the clinicians too far too fast will result in their leaving Canada to practice elsewhere.

4. Clarify the strategy for healthcare IT at a national level. Canada Health Infoway has done a remarkable job with standards and defining infrastructure for data exchange, but healthcare IT implementation is done on the provincial level. It's not clear that the Canadian Prime Minister thinks about healthcare IT or has set priorities that must be followed by all provinces.

5. Standardize outpatient/ambulatory EHRs with the same vigor that Canada has used for acute care settings. Canada has many advantages over the US to accomplish the interconnection of ambulatory records - 30 million people (1/10 of the US), a publicly funded universal healthcare system, and a provincial level healthcare identifier. It does have a challenge ensuring the connectivity of all providers across its diverse and sometimes remote geography. Creating a certification program for ambulatory EHRs and ensuring they adhere to functional capabilities and interoperability standards will enable data sharing for care coordination and population health.

The Canadians are a warm, enthusiastic, and thoughtful people. I look forward to continued collaboration and learning from each other as we implement new healthcare information technologies.